HSC provides first abortion via pill

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This article was published 29/03/2017 (3142 days ago), so information in it may no longer be current.

Manitoba’s largest health-care centre provided the province’s first medical abortion using Mifegymiso last week — and health professionals are actively pursuing a more comprehensive rollout.

The long-awaited abortion pill arrived at the Health Sciences Centre (HSC) earlier this month, a year and a half after it was first approved by Health Canada. A Common Drug Review is expected to wrap up early next month, at which point it will provide a recommendation as to whether public drug plans should cover Mifegymiso.

“The cost right now is prohibitive for many women,” said Dr. Margaret Morris, one of only two physicians currently trained to prescribe and administer the drug at HSC. “The hope is in the long term, it will improve access in rural areas.”

Right now, only a few Canadian clinics and pharmacies have access to Mifegymiso, which Celopharma Inc. started shipping in January. As of Wednesday, it was available in 10 locations. Doctors can administer it in Vancouver, Victoria, Whitehorse, Saskatoon, Calgary, Toronto, Ottawa and Winnipeg.

Mifegymiso is a pack of six pills, Morris said, two mifepristone tablets to be taken under doctor supervision and four misoprostol tablets to be taken at home the next day. The mifepristone kills the pregnancy, while the misoprostol “will initiate the process of the uterus emptying the products of conception.” Patients then have to return to the hospital within a week or so to confirm the pregnancy has ended. In five per cent of cases, women who take Mifegymiso do require surgical follow up.

But at $350 per prescription, Morris said a medical abortion is not an option many can afford. The only upside to the prohibitive cost, she said, is “it’s giving us time to really learn how to do this well.”

The process currently is somewhat cumbersome. Doctors need to date the pregnancy to confirm it is less than 50 days old before they can write the prescription (Health Canada has only approved the drug for women up to seven weeks pregnant). The patient then needs to take the prescription to the pharmacy and pay for it, at which point the pharmacy will deliver the drug to the doctor to be administered. While the misoprostol pills can be taken at home, Morris recommends patients remain close to a medical facility that could provide an emergency surgical abortion for up to two weeks after in case of an emergency.

For those who can afford it, a medical abortion can make an intensely difficult experience more personal.

“The big advantage is that it feels more private,” Morris said. “Your name will never be put up on an operating (room) slate… and you can have someone that you want to support you with you when it happens.”

While the cross-country rollout has been quite slow, the Women’s Health Clinic is hoping to offer Mifegymiso to patients as soon as this summer, according to director of health services Leigh Anne Caron. Several of the clinic’s doctors have already been trained, now it’s just a question of finding a willing pharmacy close by.

Caron said the clinic is particularly interested in offering the drug to rural patients. The Health Canada approval raised “our excitement level because it meant that there was a possibility for access for women who lived outside of Winnipeg to have medical abortions without having to travel into the city,” she said.

The clinic is looking to the Willow Women’s Clinic as an example. The Vancouver clinic offers medical abortions using Mifegymiso by Skype to women who live more than a two-hour drive away.

Caron is hopeful that a similar service can be offered to women in northern Manitoba, with patients consulting with doctors over Telehealth, but having medical care including ultrasounds and follow-up lab work done close to home.

“There just needs to be some work done around how to get training to doctors and how to support them to do this work,” she said.

In particular, Caron would like to see some sort of network clarifying who has already received the online training for Mifegymiso. She said she knew of at least one doctor in Steinbach but beyond that wasn’t sure. Dr. Morris at HSC also said she also wasn’t clear on exactly how many physicians in Manitoba were trained.

“There is a lot of work that needs to be done,” she said.

Still, Morris said HSC is working with the Women’s Clinic and Manitoba Health to see about expanding medical abortions to rural areas.

“This is happening right across the country,” she said. “How do you make this affordable for the women that might need it, so you don’t have any health equity issues?”

The Canadian Drug Expert Committee is on track with its review. This week, the committee sent its recommendation, as well as redacted copies of its review reports to Celopharma and drug plans. A final recommendation is expected in early April. A spokesperson with the Manitoba government reiterated earlier comments that a decision on funding won’t be made until that review is final.

Caron said clinic staff are optimistic.

“We’re hoping that the government will see this as an extension of the services they’re already funding and be willing to fund that medication as well.”

jane.gerster@freepress.mb.ca